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MYELOGRAPHY
Anatomic Considerations
Spinal Cord
Part of central nervous system
Two layers
– Inner layer - gray cellular substance (gray matter)
– Outer layer - white fibrous substance (white matter)
Extends from foramen magnum to L1-L2 inner-
space
Conus medullaris is a conical shaped extension
of spinal cord
MYELOGRAPHY
Anatomic Considerations
Spinal Cord (continued)
Filum terminale
– Slender, thread-like prolongation of the conus that
attaches spinal cord to coccyx
– Extension of pia mater
that penetrates dural
sac, where both attach
to coccygeal ligament
MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings - three continuous,
protective membranes (meninges)
Pia mater (little mother)
– Inner-most layer
– Adheres closely
to spinal cord
– Highly vascular
MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings (continued)
Arachnoid (spider-like)
– Web-like tissue matrix
– Separated from pia mater by subarachnoid space
• Fairly wide space with even wider spaces called
cisternae, widest of which is the cisternae magna
• Connects with the ventricular system of brain by
way of Foramen of Magendie
• Contains cerebrospinal fluid
MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings (continued)
Dura mater (tough mother)
– Strong, fibrous tissue
– Separated from arachnoid by subdural space - contains
lubricating fluid (not CSF)
– Epidural space separates dural mater from vertebral
periosteum
• Fat
• Interconnecting arteries, veins, & nerves supplying
the meninges & ligaments
– Extends to the 2nd sacral segment
– Lumbosacral segments are referred to as the dural sac
MYELOGRAPHY
Indications & Contraindications
Indications
Spinal cord tumors – identified
by location
– Extradural
• Cervical spondylosis
• Spinal tuberculosis
• Metastatic tumors
• Meningiomas
MYELOGRAPHY
Indications & Contraindications
Indications
Spinal cord tumors (continued)
– Intramedullary (within spinal cord)
• Ependymomas
• Astrocytomas
• Syringomyeloma
Cysts
Arachnoiditis
Spinal nerve root injury
Tumors in the posterior fossa of the skull
MYELOGRAPHY
Indications & Contraindications
Contraindications
Increased intracranial pressure
Intracranial disease
Infection at the puncture site
Coagulopathy
MYELOGRAPHY
The Procedure
Contrast Media
Water-soluble, non-ionic, injectible (Isovue,
Omnipaque) - contrast media of choice.
Oily (Pantopaque) - must be removed after
study.
Negative (Air, Oxygen) - readily absorbed
Pre-procedure care - keep patient well
hydrated to minimize headaches
MYELOGRAPHY
The Procedure
Equipment
Table with full-floating top, tilt, foot board, &
shoulder braces
Overhead tube permitting cross-table filming
Image intensified fluoro tower with
myelographic stop - remove lead curtain from
fluoro tower
Photo-spot camera loaded with film
Cassettes for fluoro spots &/or overheads
Lumbar puncture tray
MYELOGRAPHY
The Procedure
The Puncture
Lumbar puncture
Cisternal puncture
Sacral Hiatus puncture
CERVICAL MYELOGRAPHY
Patient Positioning
Cross-table Lateral
CERVICAL MYELOGRAPHY
Patient Positioning
Swimmer’s
THORACIC MYELOGRAPHY
Patient Positioning
Cross-table Lateral
THORACIC MYELOGRAPHY
Patient Positioning
Cross-table Obliques
THORACIC MYELOGRAPHY
Patient Positioning
Lateral Decubitus (cross-table PA)
PA
LUMBAR MYELOGRAPHY
Patient Positioning
LUMBAR MYELOGRAPHY
Patient Positioning
Cross-table Lateral (10 x 12)
LUMBAR MYELOGRAPHY
Patient Positioning
Cross-table Obliques (10 X 12)
LUMBAR MYELOGRAPHY
Patient Positioning
Lateral Decubitus (cross-table PA) (14 x 17)
PA (11 x 14)